- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.62 / $3,065.01 / $5,514.66
| Facility | | $798.62 | $3,065.01 | $5,514.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.54 / $790.21 / $798.62
| Professional | | $445.54 | $790.21 | $798.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.68 / $1,379.51 / $3,993.09
| Facility | | $882.68 | $1,379.51 | $3,993.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $689.33 / $1,642.67
| Professional | | $336.26 | $689.33 | $1,642.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.27 / $1,721.22 / $2,170.65
| Facility | | $874.27 | $1,721.22 | $2,170.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $966.01 / $1,207.51
| Professional | | $966.01 | $966.01 | $1,207.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $840.65 / $1,176.91
| Facility | | $840.65 | $840.65 | $1,176.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $1,260.98 / $2,311.79
| Facility | | $840.65 | $1,260.98 | $2,311.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.55 / $882.68 / $1,193.72
| Professional | | $714.55 | $882.68 | $1,193.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.68 / $1,379.51 / $2,311.79
| Facility | | $882.68 | $1,379.51 | $2,311.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.07 / $1,642.46 / $2,369.46
| Professional | | $761.07 | $1,642.46 | $2,369.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $353.07 / $840.65
| Professional | | $353.07 | $353.07 | $840.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.29 / $378.29 / $435.46
| Professional | | $378.29 | $378.29 | $435.46 |